Preventing the Spread of MRSA

Attention youth sports parents:
it's time to start listening to warnings from health officials about an
antibiotic-resistant skin infection or "super bug" known as
methicillin-resistant staphylococcus aureus ("MRSA").

Triple play

The October 17, 2007
MRSA-related death of a 17-year old Virginia high school student, the
release that same day of a an article by researchers at the Centers for
Disease Control (CDC) in The Journal of the American Medical Association
finding that the infection was far more common and lethal than
previously believed, and increasingly common reports of cases of
community-acquired MRSA at schools nationwide, have prompted renewed efforts by federal and state health officials and others to educate the public about the relatively simple steps that can be taken to prevent its spread.

Don't panic, health officials say

What has prompted widespread
public concern were findings by CDC researchers in the AMA journal
article that more people in the United States now die from MRSA than
from AIDS and that cases of invasive MRSA had more than doubled over
the estimated number reported just five years earlier. The percentage
of staph infections from MRSA has also increased: according to Florida
health officials, MRSA infections now account for 51 percent of
infections tested - up from 35 percent in 2003.

But health officials are quick to advise parents and athletes not to panic.

Community-acquired MRSA less dangerous than invasive form

For one thing, the vast
majority of cases of MRSA acquired outside of a hospital setting -
dubbed "community-acquired MRSA" - are the less dangerous non-invasive
form (usually appearing as skin infections).

Although the infection can,
in some cases, be virulent enough to lead to bloodstream infections, or
bone infections requiring intravenous drug treatment in a hospital,
community-acquired MRSA:

Is usually mild; Is more easily and effectively treated (by draining the pus, with or without antibiotics);

Usually responds well to certain antibiotics, albeit ones that can cost as much as $80 per day; and

Preventable.

Good hygiene dramatically lowers risk of infection

For another, as discussed in
detail below, the risk of infection can be lowered dramatically by
practicing good personal hygiene (hand washing etc.).

Other illnesses pose greater health risk

Finally, it is important to
remember, say health officials, that, while MRSA is getting a lot of
attention (especially in the wake of the Virginia student's death),
ordinary flu poses more of a health threat, killing an estimated 36,000
people this year in the USA.

Risk factors: The 5 C's

According to the CDC, settings that make it easier for MRSA to be transmitted often involve the 5 C's:

Crowding

Frequent skin-to-skin Contact

Compromised skin (i.e. cuts or abrasions)

Contaminated items and surfaces; and

Lack of Cleanliness.

Health officials generally agree that sports teams seem most at risk for staph infections such as community-acquired MRSA.

In the sports context, the CDC has identified three factors that are seen as contributing to the outbreaks:

Sports resulting in skin abrasions. Athletes, especially those playing on artificial turf,
can suffer turf burns, abrasions and other skin trauma. Turf burns "are
just the kind of minor skin injury that MRSA can exploit," according to
Elliot Pellman, medical liason for the National Football League. Even
in sports with less direct contact, protective clothing can be hot and
might chafe skin, resulting in abrasions and lacerations (e.g. fencers
reported developing skin rashes frequently under protective clothing).

Sports involving frequent physical contact. Some sports for which MRSA infections have been reported
involve frequent physical contact among players (e.g., football and
wrestling). Infections can be transmitted easily from person to person
with direct contact.

Sports requiring athletes to share heavy protective clothing and equipment.
Sports such as fencing have limited skin-to-skin contact but require
multiple pieces of protective clothing and equipment, which often might
be shared. The use of shared equipment or other personal items that are
not cleaned or laundered between uses could be a vehicle for
transmission.

Recognizing Possible Staph Infections

Because the infection often
looks like an ordinary skin wound or boil, diagnosis is difficult.
Treatment with penicillin-related antibiotics is ineffective.

Thus, one of the keys to
preventing the spread of MRSA and other staph infections is to be able
to spot and hence treat skin infections.

Coaches, parents, and athletes should be on the look out for:

Skin
infections that may appear as pustules or boils at the site of visible
skin trauma, such as cuts and abrasions, and areas of the body covered
by hair (e.g. back of neck, groin, buttock, armpit, beard area);

Fever;

Pus or other drainage;

Swelling; and/or

Pain

"It's important for coaches and
parents to be aware MRSA might be a cause of skin problems in
children," Dr. Dan Jernigan, a CDC medical epidemiologist, told the
Associated Press.

General Prevention Steps

The best ways to prevent the spread of staph infections such as MRSA are to maintain good personal hygiene and avoid direct contact with skin lesions of other players.

All persons associated with
competitive sports teams, including players, coaches, teachers,
parents, and administrators, can help prevent sports-related skin
infections and should be aware of the prevention measures set out
below.

The CDC recommends that:

Sports
team administrators be encouraged to provide facilities and equipment
necessary to promote good hygiene, such as clean facilities and
adequate supplies of soap and towels.

Coaches and parents should:

Encourage good player hygiene (e.g. keeping hands clean by washing with soap and water or using an antibacterial hand sanitizer)

Teach
players to avoid sharing towels, razors or other personal items that
come into contact with bare skin, use a barrier (e.g. clothing or
towel) between their skin and shared equipment such as weight-training
benches, and inform coaches about active skin infections;

Be taught to administer proper first aid,

Practice appropriate hand hygiene themselves, and

Implement a system to ensure adequate wound care and to cover skin lesions appropriately before play.

Prevention Tips: Specific Advice for Athletic Programs

The CDC also recommends the following specific steps to prevent the spread of skin infections among athletes:

Launder personal items such as towels and supporters after each use. The water should be at least 160 degrees; washing time should be 25 minutes or more. One product that MomsTeam loves is FabricAide

Clean and cover all wounds.
If an athlete's skin is injured, it should be washed immediately with
soap and warm water, dried and covered with a clean bandage. If a wound
cannot be covered adequately, the program should consider excluding
players with potentially infectious skin lesions from practice or
competition until the lesions are healed or can be covered adequately;

Encourage good hygiene,
including washing hands often, using soap or a antibacterial gel or
lotion, showering and washing with soap after every practice or
tournament;

Ensure availability of adequate soap and hot water;

Discourage sharing of towels and personal items;

Establish routine cleaning schedules for shared equipment.
Shared athletic equipment, such as pads or helmets, should be cleaned
or laundered at least once a week but ideally after each use;

Train athletes and coaches in first aid for wounds and recognition of wounds that are potentially infected;

Encourage athletes to report skin lesions to coaches; and

Encourage coaches to assess athletes regularly for skin lesions.

For the guidelines recently
reissued by the National Association of Athletic Trainers on proper
prevention of MRSA and other communicable diseases that can be spread
by athletic participation, click here

Pro-active schools

Some particularly pro-active school systems are going even further in their efforts to prevent the spread of MRSA, including:

Having students apply an anti-bacterial hand sanitizer when getting on school buses;

Requiring
students to apply anti-bacterial hand sanitizer provided by their
teachers first thing in the morning, before lunch, and after using the
bathroom;

Supplying hand sanitizer to support and maintenance staff; and

Installing hand sanitizer dispensers in all classrooms.

Prevention and Treatment at Home

There are a number of steps
parents and athletes can take at home to prevent the spread of
communicable skin diseases such as MRSA, and to treat the infection,
including

Regularly
cleaning commonly touched areas, such as doorknobs, light switches,
computer keyboards and games, with a disinfectant (an inexpensive
disinfectant can be made by mixing one tablespoon of bleach to one
quart of water)

Requiring that everyone in the household use his or her own towel;

Washing hands before and after making contact with someone or their personal possessions; and

Cleaning
any cut with soap and water and then applying a topical
over-the-counter "maximum strength" or "triple antibiotic"
anti-bacterial ointment. While there are, as of yet, no
clinical studies to confirm the results, a laboratory study conducted
at the College of Pharmacy at Oregon State University (OSU) presented
at a December 2007 meeting of the American Society of Health-System
Pharmacists found that an ointment containing benzethonium chloride
with tea tree and white thyme oil worked best against all four tested
MRSA strains, while ointments containing neomycin, polymyxin, and
gramicidin also had some antibacterial effectiveness.

"We know that it takes a large number of bacteria to
ultimately produce an infection, and antibacterial treatments can
greatly reduce their number" said David Bearden, a clinical associate
professor at OSU. "It's reasonable to believe that these products,
which are inexpensive and easily available, have a place in protecting
a nasty cut or scrape and trying to prevent a more serious infection."

Parents should also think twice about asking their child's pediatrician
to prescribe antibiotics for the flu, or another virus, an ear
infection, or adolescent acne. Why? Because, health officials say, the
overuse of antibiotics has contributed to the resistance staph
bacterium have developed to the most common antibiotics. Indeed, the
growing public concern about MRSA has prompted many dermatologists
(fifty percent, according to one report) to cut back on the use of
antibiotics to treat acne.